Lack of medical malpractice coverage threatens midwives

HUNDREDS of midwives could be forced out of business because insurers are refusing to provide professional indemnity cover.

Under new rules drawn up by the Department of Health (DoH) all health professionals must take out liability insurance by 2008. NHS staff receive protection from the NHS litigation Authority, but this does not cover non-NHS staff.

The Independent Midwives Association (IMA) said potential payouts are putting off Insurers. Currently, 80% of NHS litigation costs relate to obstetrics, with individual claims running to millions of pounds.

Lynn Walcott, an IMA spokeswoman, said: “At the moment, independent midwives have no choice but to work without insurance. We just can’t get cover. This isn’t just a British problem, it’s something midwives are experiencing worldwide. If this situation continues, our work could become illegal in 2008 when the new rules come in.”

The IMA wants members to be exempted from insurance rules, or for measures to ensure they have access to affordable insurance to be introduced. One option involves giving independent midwives access to NHS cover.

The Association of British Insurers (ABI) is appealing to the government to delay the introduction of new regulations while insurers work out a solution and a meeting has been arranged with the government’s chief nursing officer later this month.

ABI spokesman Malcolm Tarling said: “At the moment we are not aware of stand-alone insurance policies specifically for independent midwives. The reason for this is the huge nature of the risks involved and spiralling personal injury awards. When things go wrong during childbirth, the cost of life-long care can be enormous.

“We will be meeting with the chief nursing officer at the end of the month to look at ways we might resolve this. We cannot dictate to companies but we hope we can open up a debate on this.”

Chief nursing officer Christine Beasley insisted the changes would go ahead in the interests of safety. She said: “It is clearly in the public’s interest for all registered healthcare professionals to have professional indemnity insurance in the event of a claim for negligence. While it is important to support the employment of independent midwives, especially in relation to choice and diversity of provision, we must consider the protection of the woman and her unborn child”

Professional indemnity specialist Phil Smith, at broker Lockton, said the UK market was considering various options. He said: “We are in discussions with the IMA regarding access to adequate medical malpractice insurance. Historically, NHS midwives were covered for medical malpractice by the Royal College of Midwives but when this ceased, they were given the option to secure cover with mutual funds. This was withdrawn in 1994 due to under-reserving and high deficits. Some premiums were astronomical — in the region of £18,000 per annum. Since then, midwives have been unable to get the med-mal cover the DoH requires.

“Lockton is hoping to leverage the soft market to structure an exclusive innovative product providing affordable, medical malpractice insurance to midwives.” But midwives fear a solution will not be found in time. Walcott said: “We would welcome anything an insurer comes up with. Independent midwives are not a high risk in terms of claim numbers. But when you get a claim it can run to many millions. In the past, we have found when insurers get down to the nitty gritty, they get cold feet and pull out”

The Medical Defence Union. which previously insured independent midwives, said there were no plans to reintroduce cover.

Demand for independent midwives is growing in the UK due to acute NHS shortages and more women opting for home births. The Royal College of Midwives said the NHS shortfall was around 10,000. There are around 300 midwives working independently. Midwives worldwide are facing similar problems. In Miami, a midwifery training course is on the verge of closure due to the high cost of medical malpractice insurance. Students on the three year course are crippled by premiums of $6,000 a year when the cost of training is just $1,700.